O1-8 Evaluation of the implementation of the ‘Living well with COPD' self-management program in Switzerland

Abstract Background Self-management can improve health status and reduce hospitals admissions in patients with chronic obstructive pulmonary disease (COPD). The aim of this mixed-methods study was to evaluate the implementation of the ‘Living well with COPD’ self-management program, a nation-wide effort by the Swiss Lung Associations and the Swiss society of pulmonary medicine. Methods For the implementation evaluation we used qualitative (interviews, focus groups) and quantitative (questionnaires, documentation analysis) methods to assess indicators of the outcomes reach, dose, fidelity, acceptability and appropriateness of the program. To evaluate the effectiveness, we assessed exercise capacity (1-minute sit-to-stand test), disease specific quality of life (Chronic Respiratory Questionnaire CRQ), symptoms, health care utilisation and health behaviour including physical activity at baseline and at the end of the program (after 12 months). Results Seven Cantonal Lung Associations implemented the program into their services according to plan, conducted it 13 times during 1 year and included in total 122 COPD patients (mean age 69 years, 48% female). The patients' attendance rate and the coaches' fidelity to the protocol were high (81% and 94%, respectively). Overall, acceptance and satisfaction of all involved persons (patients, coaches, responsible persons from the Lung Associations) was very high; they particularly acknowledged the meaningfulness of the program. Challenges were sustainable funding, integration of the coaches' additional workload and uncertainties regarding roles and responsibilities. After 14 month, the patients did not just avoid a decline in exercise capacity and health status but significantly improved in the 1-minute sit-to-stand test (23.9 vs. 27.1 repetitions) and in 3 of 4 CRQ subscales (with 0.2-0.5 units). Conclusions The ‘Living well with COPD' program was successfully implemented despite a tight schedule and showed a remarkably positive impact of the COPD patients' health status. The insights of this study will support the broader multiplication of the program throughout Switzerland and also serves the international community since it is one of the first nation-wide implementations beyond study settings.


Background
Self-management can improve health status and reduce hospitals admissions in patients with chronic obstructive pulmonary disease (COPD). The aim of this mixed-methods study was to evaluate the implementation of the 'Living well with COPD' self-management program, a nation-wide effort by the Swiss Lung Associations and the Swiss society of pulmonary medicine.

Methods
For the implementation evaluation we used qualitative (interviews, focus groups) and quantitative (questionnaires, documentation analysis) methods to assess indicators of the outcomes reach, dose, fidelity, acceptability and appropriateness of the program. To evaluate the effectiveness, we assessed exercise capacity (1-minute sit-to-stand test), disease specific quality of life (Chronic Respiratory Questionnaire CRQ), symptoms, health care utilisation and health behaviour including physical activity at baseline and at the end of the program (after 12 months).

Results
Seven Cantonal Lung Associations implemented the program into their services according to plan, conducted it 13 times during 1 year and included in total 122 COPD patients (mean age 69 years, 48% female). The patients' attendance rate and the coaches' fidelity to the protocol were high (81% and 94%, respectively). Overall, acceptance and satisfaction of all involved persons (patients, coaches, responsible persons from the Lung Associations) was very high; they particularly acknowledged the meaningfulness of the program. Challenges were sustainable funding, integration of the coaches' additional workload and uncertainties regarding roles and responsibilities. After 14 month, the patients did not just avoid a decline in exercise capacity and health status but significantly improved in the 1-minute sit-to-stand test (23.9 vs. 27.1 repetitions) and in 3 of 4 CRQ subscales (with 0.2-0.5 units).

Conclusions
The 'Living well with COPD' program was successfully implemented despite a tight schedule and showed a remarkably positive impact of the COPD patients' health status. The insights of this study will support the broader multiplication of the program throughout Switzerland and also serves the international community since it is one of the first nation-wide implementations beyond study settings. Keywords: Self-management program, exercise capacity, implementation evaluation, chronic disease, chronic obstructive pulmonary disease

Active ageing
Abstract citation ID: ckac094.009 O2-1 Improving diet and physical activity in adults living at home: protocol for the cluster randomized controlled trial

Background
Adequate nutrition and regular physical activity (PA) are key elements in healthy aging. In France, behavioural interventions promoting healthy eating and PA in older adults consist mainly in collective workshops organised by pension and health insurance funds. After analyzing pre-existing workshops, we designed the co-constructed project ALAPAGE to improve these workshops and assess their impact on diet and PA. Methods ALAPAGE is a cluster randomized controlled trial; 60 collective workshops in southeastern France will be randomized in a 2:1 (intervention/control) ratio. We will recruit 900 autonomous older adults (? 60 years) living at home and will make specific efforts to recruit socially isolated and/or economically vulnerable people. In the intervention group, collective workshop period will include 7 sessions (1 session/ week): 1 introductory, 4 diet and 2 PA (to teach principles of functional dual-task exercise focused on strength, flexibility and physical functioning). During the following 3-months, participants will be recommended to perform exercises as often as possible and will participate in post-workshop activities. The control group will first participate to other types of workshops and then to a diet and PA workshop (waiting-list design).

Results
The dietary practices (using experimental economics), physical activity (battery of field test and habitual PA), quality of life, and cost-effectiveness will be assessed at the first and last session, and 3 months later. Conclusion Results will guide decision-makers to organize actions and their dissemination. Transferability to other regions will be methods, longitudinal investigation of predictors, barriers and enablers of adherence to REACT, a 12month group-based, active-ageing programme Background Physical activity (PA) programmes targeting older adults often report relatively low attendance rates which limits impact. Research into barriers and enablers of PA adherence is often qualitative and rarely tests outcomes against objectively monitored adherence to assess whether what people say is actually reflected in what they do. This study adopts a rare, mixed methods, longitudinal perspective identifying subjective and objective predictors of and associations with adherence to REtirement in ACTion (REACT), a 12-month physical activity intervention for frail or pre-frail older adults. Methods Semi-structured interviews conducted at six (n = 17) and 12 months (n = 10) explored barriers and enablers to adherence. Thematic analysis led to ten adherence related research hypotheses. These were tested by examining correlations between REACT programme attendance and physical function (Short Physical Performance Battery), self-rated physical function (mobility assessment tool-short form (MAT-sf)), dominant hand grip strength assessed by digital dynamometer, Ageing Well profile (social scale), process evaluation data at baseline (n = 411) and six-months (n = 348) and open-ended participant feedback at six-months (n = 307). Each participant response was scored -1) for a negative comment, 1 for positive or zero for no comment or balancing negative and positive comments.